From single risks to cumulative burden: Determinants of cholelithiasis in young adults
Keywords:
cholelithiasis, young adults, cumulative risk burden, obesity, metabolic riskAbstract
Background and aim: Cholelithiasis has traditionally been considered a disease of older adults; however, its incidence among young adults is increasing worldwide. Most previous studies have focused on isolated risk factors, despite growing evidence that gallstone formation is a multifactorial process involving the accumulation of multiple modest risk factors. This study aimed to evaluate the association between cumulative exposure to selected metabolic and demographic risk factors and the presence of cholelithiasis among young adults in a Southeast Asian population. Methods: A hospital-based case–control study was conducted among adults aged 18–39 years at a tertiary referral center in Indonesia. A total of 141 participants were included (47 cases with cholelithiasis and 94 controls). Cholelithiasis was confirmed by abdominal ultrasonography or computed tomography. Independent variables included sex, body mass index (BMI), lipid profile, total bilirubin, physical activity, and a cumulative risk burden score constructed from multiple concurrent risk factors. Multivariable logistic regression analysis was performed. Results: Female sex (adjusted OR 2.67; 95% CI 1.12–6.35) and obesity (adjusted OR 2.81; 95% CI 1.08–7.32) were independently associated with cholelithiasis. Individual metabolic parameters were not significant when analyzed separately. In contrast, participants with more than four concurrent risk factors had a substantially higher likelihood of cholelithiasis (adjusted OR 4.50; 95% CI 1.43–14.19), indicating a pattern of risk accumulation when multiple modest risk factors coexist rather than evidence of a biological threshold or synergistic effect. Conclusions: Young-onset cholelithiasis appears to be associated with the cumulative burden of multiple modest risk factors rather than any single dominant determinant. Quantifying cumulative risk burden may offer an exploratory framework for early risk stratification and prevention in metabolically transitioning populations.
Key words: cholelithiasis; young adults; cumulative risk burden; obesity; metabolic risk
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Copyright (c) 2026 Safrina Dwiyunarti, Rini R Bachtiar, Himawan Sanusi, Sudirman Katu, Arifin Seweng
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